Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study

Background: Vaccination is an important tool for reducing infectious disease morbidity and mortality. In the past, less than 80% of children 12–23 months of age were fully immunized in Burkina Faso. Objectives: To describe coverage and assess factors associated with adherence to the vaccination schedule in rural area Burkina Faso. Methods: The study population was extracted from the Nouna Health and Demographic surveillance system cohort. Data from four rounds of interviews conducted between November 2012 and June 2014 were considered. This study included 4016 children aged 12–23 months. We assessed the effects of several background factors, including sex, factors reflecting access to health care (residence, place of birth), and maternal factors (age, education, marital status), on being fully immunized defined as having received Bacillus Calmette–Guérin (BCG), three doses of diphtheria–tetanus–pertussis and oral polio vaccine, and measles vaccine by 12 months of age. The associations were studied using binomial regression to derive prevalence ratios (PRs) in univariate and multivariate regression models. Results: The full vaccination coverage increased significantly over time (72% in 2012, 79% in 2013, and 81% in 2014, p = 0.003), and the coverage was significantly lower in urban than in rural areas (PR 0.84; 0.80–0.89). Vaccination coverage was neither influenced by sex nor influenced by place of birth or by maternal factors. Conclusion: The study documented a further improvement in full vaccination coverage in Burkina Faso in recent years and better vaccination coverage in rural than in urban areas. The organization of healthcare systems with systematic outreach activities in the rural areas may explain the difference between rural and urban areas.

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“…This difference in coverage between these two sets of vaccines has also been documented in other studies in developing countries [30–32]. …”

Section: Discussionsupporting

confidence: 79%

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

Kagoné

Yé

Nebié

et al. 2017

Global Health Action

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“…Assessment of the long-term effects of the vaccination schedule on morbidity and mortality has been limited [71]. In this pilot study of vaccinated and unvaccinated homeschool children, reduced odds of chickenpox and whooping cough were found among the vaccinated, as expected, but unexpectedly increased odds were found for many other physician-diagnosed conditions.…”

Section: Discussionsupporting

confidence: 48%

Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12- year old U.S. children

Mawson¹,

Ray²,

Bhuiyan³

et al. 2017

J Transl Sci

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Vaccinations have prevented millions of infectious illnesses, hospitalizations and deaths among U.S. children, yet the long-term health outcomes of the vaccination schedule remain uncertain. Studies have been recommended by the U.S. Institute of Medicine to address this question. This study aimed 1) to compare vaccinated and unvaccinated children on a broad range of health outcomes, and 2) to determine whether an association found between vaccination and neurodevelopmental disorders (NDD), if any, remained significant after adjustment for other measured factors. A cross-sectional study of mothers of children educated at home was carried out in collaboration with homeschool organizations in four U.S. states: Florida, Louisiana, Mississippi and Oregon. Mothers were asked to complete an anonymous online questionnaire on their 6-to 12-year-old biological children with respect to pregnancy-related factors, birth history, vaccinations, physician-diagnosed illnesses, medications used, and health services. NDD, a derived diagnostic measure, was defined as having one or more of the following three closely-related diagnoses: a learning disability, Attention Deficient Hyperactivity Disorder, and Autism Spectrum Disorder. A convenience sample of 666 children was obtained, of which 261 (39%) were unvaccinated. The vaccinated were less likely than the unvaccinated to have been diagnosed with chickenpox and pertussis, but more likely to have been diagnosed with pneumonia, otitis media, allergies and NDD. After adjustment, vaccination, male gender, and preterm birth remained significantly associated with NDD. However, in a final adjusted model with interaction, vaccination but not preterm birth remained associated with NDD, while the interaction of preterm birth and vaccination was associated with a 6.6-fold increased odds of NDD (95% CI: 2.8, 15.5). In conclusion, vaccinated homeschool children were found to have a higher rate of allergies and NDD than unvaccinated homeschool children. While vaccination remained significantly associated with NDD after controlling for other factors, preterm birth coupled with vaccination was associated with an apparent synergistic increase in the odds of NDD. Further research involving larger, independent samples and stronger research designs is needed to verify and understand these unexpected findings in order to optimize the impact of vaccines on children's health.

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“…This process has not contributed to better health. 48 It would seem more logical to use BCG and MV, which are associated with better child survival, 17,18 to monitor performance of the vaccination program.…”

Section: Discussionmentioning

confidence: 99%

Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine

Aaby

Ravn

Fisker

et al. 2016

Trans R Soc Trop Med Hyg

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BackgroundTen years ago, we formulated two hypotheses about whole-cell diphtheria-tetanus-pertussis (DTP) vaccination: first, when given after BCG, DTP increases mortality in girls and, second, following DTP there is an increase in the female/male mortality rate ratio (MRR). A recent review by WHO found no convincing evidence that DTP increases mortality in females.MethodsWe used previous DTP reviews as well as the recent WHO review for assessing the hypotheses. As pre-specified we excluded studies with survival or frailty bias; if children had received BCG and DTP simultaneously; and if the children had received neonatal vitamin A.ResultsIn seven studies of BCG-vaccinated children, DTP vaccination was associated with a 2.54 (95% CI 1.68–3.86) increase in mortality in girls (with no increase in boys [ratio 0.96, 0.55–1.68]). In 10 studies of BCG-vaccinated children, the female-to-male mortality ratio was 2.45 (1.48–4.06) times higher after DTP than before DTP. In 15 studies of children who had received DTP after previous BCG vaccination, mortality was 1.53 (1.21–1.93) times higher in girls than boys. The findings were similar in studies conducted before and after formulation of the hypotheses.ConclusionsThe two hypotheses were confirmed in the studies that fulfilled pre-specified criteria.

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Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study

Abstract: DANIDA, European Research Council, the Danish Independent Research Council, European Union FP7 via OPTIMUNISE, and Danish National Research Foundation.

Cited by 41 publications

References 28 publications

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12- year old U.S. children

Is diphtheria-tetanus-pertussis (DTP) associated with increased female mortality? A meta-analysis testing the hypotheses of sex-differential non-specific effects of DTP vaccine

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